MEDICARE: DIANE HAYNES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	358027	NY
2	163W00000X	Registered Nurse	708471	NY

General Provider Information

NPI Number	:	1790338382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE HAYNES

Provider Business Mailing Address
First Line	:	419 COOLIDGE AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-3307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 PRINCE ST STE 3C
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4650
Country	:	US
Telephone Number	:	718-380-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	03/31/2026

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Directions to “ DIANE HAYNES ” Practice Location

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